HIGH YIELD II

Question 1

Most women with typical symptoms of uncomplicated cystitis (high pre-test
probability) do not need to submit a urine
–No U/A, microscopy, or culture

If symptoms atypical to dipstick and/or urine microscopy
– Negative dipstick does not completely rule out cystitis, but pyuria on microscopy is present in almost all women with cystitis

Urine culture only if indicated

Answer 1

Abbreviated Evaluation

Question 2

tx?

Answer 2

empirical for acute uncomplicated cystitis without use of urine cultures

trimethoprim-sulfamethoxazole DS, 1 PO twice daily

nitrofurantoin, 100 mg PO twice daily

fosfomycin, 3 grams PO

Question 3

most common nosocomial infection?

Answer 3

CA bacteriuria, most common source of gram negative bacteremia in hospitalized patients

Question 4

incidence of bacteriuria with catheter?

strongest risk factor for bacteriuria?

less than 25% of pts with CA bacteriuria develop?

Answer 4

3-10% per day

duration of catheterization

UTI symptoms

Question 5

site of possible contamination?

2/3 of infections are extraluminal which equals=

1/3 are intraluminal due to stats which equals=

Answer 5

catheterization of urinary tract

biofilm

ascending from bag

Question 6

common finding with catheterized patients with bacteriuria, whether symptomatic or not?

Answer 6

pyuria

Sensitivity of pyuria for CA-bacteriuria was 47%,
specificity 90%, and positive predictive value 32%

Question 7

nonspecific signs and symptoms for CA-UTI, neurogenic bladder?

Answer 7

new onset fever
malaise or lethargy
CVA tenderness
acute hematuria
pelvic pain
spinal cord injuries
altered mental status

Question 8

odor and cloudiness of urine indicate?

Answer 8

poor sensitivity and specificity for CA-UTI

not an indication for urine culture or ABx

Question 9

T/F? clinicians are unaware their pt is catheterized

catheters should not be used for for the management of urinary incontinence, T/F?

Answer 9

true

true

Question 10

> 1,000,000 cases in US annually
– ~20% of pyelo in young women require hospitalization

Traditional classification:
– Uncomplicated vs. complicated pyelonephritis

Both can progress to sepsis and shock

IDSA UTI guidelines in 2011 included treatment of acute uncomplicated pyelonephritis

pathogenesis: ascending from bladder

RF: same as cystitis, although <3% of cystitis cases progress to upper tract infection

what is this?

Answer 10

acute pyelonephritis

Question 11

what is uncommon in uncomplicated pyelonephritis?

how does acute pyelonephritis present?

Answer 11

E coli >90% usually occurs, MRSA is uncommon

temp>100F, chills, flank pain, CVA tenderness, N/V

Question 12

how is acute pyelonephritis diagnosed?

Answer 12

send urinanalysis

GU tract imaging

Question 13

Common problem, often elderly women

IDSA definition:
– No symptoms or signs of UTI

Bladder colonization with a uropathogen (normally sterile)

what is this?

Answer 13

Asymptomatic Bacteriuria (ASB)